Brainstem glioma

Last revised by Joshua Yap on 13 Oct 2022

Brainstem gliomas consist of a heterogeneous group that varies greatly in histology and prognosis. Unless otherwise specified, the term brainstem glioma usually refers to the most common histology of a diffuse midline glioma H3 K27-altered although many other gliomas can be encountered in the brainstem (e.g. pilocytic astrocytomaganglioglioma, etc.). As such, caution must be used when using this term as it is vague. 

Although the exact presentation will vary according to the location and size of the tumor, in general patients will exhibit a combination of 4:

The duration of symptoms is usually much shorter in diffuse gliomas (in contrast to focal gliomas), in which the history is typically very short (a few days) 4. Additionally, diffuse gliomas more frequently have multiple cranial nerve palsies.

As a general rule, mesencephalic tumors tend to be of a lower grade than those in the pons and medulla 3.

  • pontine

  • mesencephalic

  • medullary

    • least common location

    • includes focal dorsally exophytic, focal, diffuse and cervicomedullary junction variants

    • cervicomedullary junction tumors usually represent upper cervical tumors extending superiorly

    • most common location for NF1 associated tumors

MRI is the imaging modality of choice. The appearance will vary with the tumor type, thus please refer to individual articles. 

May show anterior displacement of the basilar artery.

Again, both treatment and prognosis are significantly influenced by tumor type, morphology and location. Radiation is a key part of treatment as surgical resection is usually not possible.

As a general rule, dorsal exophytic tumors and cervicomedullary tumors tend to do best with surgery, whereas surgery has no role in the management of diffuse brainstem gliomas.

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